MS Treatments (July 2017)

 First-line treatment

1. Interferon beta-1b
   Extavia (Novartis)
   Betaferon (Bayer)
   The first drug that was approved for treatment of MS, interferon beta-1b inflammation in the central nervous system.
   Injectable
   The most common side effects include injection site reactions and GI symptoms, such as stomach pain, constipation, and diarrhoea
2. Interferon beta-1a
   Avonex (Biogen)
   Rebif (Serono)
   An injectable medication, interferon beta-1a reduces inflammation, possibly through the reduction of T cell production and also reduction of inflammatory cells in the CNS. Like interferon beta- 1b, it is believed to prevent the crossing of inflammatory cells through the blood-brain barrier
   Injectable
   The most common side effects include injection site reactions and fevers
3. Glatiramer acetate (by Mylan)
   This immunomodulator is used to prevent relapses.
   Subcutaneous injectable
   Glatiramer acetate -generic equivalent of Copaxone 20 mg and 40 mg doses
   The most common side effects include injection site reactions, fevers, double vision, weakness, and swelling of the hands or feet
   Patient information
4. Copaxone (by Teva)
   This immunomodulator is used to prevent relapses.
   Subcutaneous injectable
   The most common side effects include injection site reactions, fevers, double vision, weakness, and swelling of the hands or feet
   Patient information
   
5. Dimethyl Fumarate (Tecfidera by Biogen)
   This works as an anti-inflammatory by blocking cytokine induction.
   Oral medication
   The most common side effects include flushing, rash, and GI symptoms
6. Peginterferon beta-1a (Plegridy by Biogen)
   Similar to interferon is believed to have an extended duration.
   Injectable
   The most common side effects include injection site reactions, fevers. and joint pain
7. Daclizumab (Zinbryta by Biogen)
   Zinbryta (daclizumab) was withdrawn from the worldwide market on March 2, 2018. Please see important information about the withdrawal in Society News.
   This medication is believed to reduce T cells. The suggested mechanism is through binding to the IL- 2 T cell receptors
   Subcutaneous injectable
   The most common side effects include upper respiratory tract infection and skin rash
8. Teriflunomide (Aubagio by Sanofi Genzyme)
   This immunomodulatory drug is believed to work by inhibiting the proliferation of T cells and B cells.
   Oral medication
   It may cause abnormal liver tests, flu-like symptoms, and thinning hair

Second-line treatments

1. Fingolimod (Gilenya by Novartis)
   This is believed to lower the number of lymphocytes in the blood by binding to T cells
   Oral medication
   The most common side effects include headaches and flu-like symptoms. This medication may cause some patients to have abnormal liver tests
2. Natalizumab (Tysabri by Biogen)
   It is an antibody that is reported to prevent leukocyte entry into the body’s organs
   IV administration
   Tysabri can cause headaches and joint pain, and has also been associated with progressive multifocal leukoencephalopathy, a rare disorder affecting the brain that causes seizures and paralysis and may progress to death
3. Ocrelizumab (Ocrevus by Genentech)
   This agent was approved for the treatment of relapsing-remitting MS in March 2017 and is believed to act against B cells
   IV administration
   Thus far, there is little clinical experience with Ocrevus, but studies showed infusion reactions such as pruritus, rash, urticaria, and erythema as well as an increase in respiratory infections and herpes virus infections

Second or third-line treatments

1. Mitoxantrone (Novantrone)
   This antineoplastic agent is believed to work by disrupting the synthesis of DNA
   IV administration
   A relatively powerful agent, it may cause hair loss, menstrual changes, and GI symptoms
2. Alemtuzumab (Lemtrada by Sanofi Genzyme)
   This a recombinant humanized IgG1 kappa monoclonal antibody decreases the number of immune cells. Considered a powerful agent, Lemtrada is generally reserved for patients who have had inadequate response to other disease modifying agents
   IV administration
   Therapy may cause rash, headaches, and fevers.

Symptomatic treatment

Fampyra (Biogen)
Slow release tablet for the treatment of walking difficulties in people with MS
Oral medication
The most common side effect reported in clinical studies, affecting around 12% of the patients, is urinary tract infection

Also see:

• Disease Modifying Therapies: A review of the perspectives of Irish people with MS (Get Adobe® Reader® for free)

Important patient information

Maintaining your DMT is vital if you want to maximise your treatment effectiveness. Please contact your medical team if you have any concerns.

For a more detailed list of available treatments, please click here.

Treatment and managing MS (by MS Ireland)

MS Treatment Decisions (by MS Ireland)

Source: Neurology Times and World Journal of Clinical Cases

Date: June 16th, 2018

© Willeke Van Eeckhoutte and Ireland, Multiple Sclerosis & Me, 2011-2018. Unauthorised use and/or duplication of this material without express and written permission from this blog’s author and/or owner are strictly prohibited.